It's Time for Realism
Among readers of The Nation who follow the drug issue, it's an article of faith that the war on drugs has failed miserably. The clogging of our prisons with low-level drug offenders, the widespread curtailment of civil liberties in the name of drug enforcement, the strained relations with drug-producing nations to our south, the whole puritanical mindset associated with Just Say No--all have contributed to a consensus on the urgent need for change.
As to what that change should be, there are some clear areas of agreement. Virtually all liberals, for instance, would like to see the police stop making so many drug arrests, which currently number more than 1.5 million a year. Everyone, too, would like to see an overhaul of the nation's harsh and discriminatory drug-sentencing laws--a step that would, among other things, reverse the relentless flow of black and Latino men into prison.
Beyond that, though, the consensus breaks down. And this has helped stall the movement for reform. Despite growing dissatisfaction with the drug war among the general public, progress toward change has been minimal, and the inability of liberals to propose a persuasive alternative helps explain why.
On the left, three schools of drug reform prevail. Each has something to offer but, by itself, is an inadequate guide to change. The most sensational is the CIA-trafficking school. Actually, this is less a school than a tendency, limited to certain sectors of the left, but it has absorbed much intellectual energy over the years, beginning with Alfred McCoy's 1972 study The Politics of Heroin in Southeast Asia and extending through Senator John Kerry's Congressional investigation in the eighties and, more recently, Gary Webb's book Dark Alliance. According to this perspective, America's drug problem cannot be fully understood without examining the CIA's periodic alliances with drug-running groups abroad, from the Hmong tribesmen in Laos to the mujahedeen in Afghanistan to the contras in Nicaragua. By teaming up with and providing cover to these forces, it is alleged, the CIA has facilitated the flow of drugs into the United States at critical moments. In the most eye-popping version of this theory, advanced by Gary Webb, traffickers linked to the CIA-backed contras are said to have supplied cocaine to major dealers in South Central Los Angeles, thus helping to set off the nation's crack epidemic. Though well aware of this activity, the CIA did nothing to intervene. (This theory was seized upon by some leaders of the black community, including Congresswoman Maxine Waters, who wrote a glowing foreword to Webb's book.)
With its chronicling of the CIA's ties to drug-tainted groups, the CIA-trafficking school deserves credit for exposing the hypocrisy of the drug war. It also raises important questions about the types of alliances the United States sometimes makes abroad. As a guide to drug reform, though, it's a dead end. However much the contras were involved in drug trafficking (and the evidence strongly suggests they were), they were clearly no more than bit players in the overall cocaine trade. If any one group was primarily responsible for the flow of cocaine into the United States, it was the Colombian traffickers, and no one has accused the CIA of abetting them. On the contrary, the US government has for the past fifteen years been waging all-out war on the Colombian narcos, with little to show for it.
Adherence to the CIA-trafficking school leads one into some strange policy terrain. In focusing so strongly on the intelligence agency, this school seems implicitly to accept the idea that Washington could actually do something about the flow of drugs into the United States if it really wanted to. If only the CIA would fight the traffickers, rather than shield them, it's implied, we could reduce the availability, and abuse, of drugs in this country. Yet, after thirty years of waging war on drugs, it should be apparent that with or without the CIA's help, the United States is incapable of stemming the flow of drugs into this country. The CIA-trafficking school unwittingly bolsters the idea that the true source of America's drug problem lies outside our borders, and that the solution consists in cracking down on producers, processors and smugglers. In an odd way, then, this school actually reinforces the logic underlying the drug war.
By now, it should be clear that America's drug problem is home-grown, and that any effort to combat it must be centered here. In particular, we must confront the real source of our problem--the demand for drugs. On this point, many liberals subscribe to the "root causes" school. This holds that the problem of drug abuse in America reflects deeper ills in our society, such as poverty, unemployment, racial discrimination and urban neglect. To combat abuse, we must first address these underlying causes--through policies to promote full employment, increase the minimum wage, provide universal health insurance, end housing segregation and create opportunities for disadvantaged youths.
In focusing attention on the link between poverty and drug abuse, the root-causes school provides a valuable service. Studies indicate that drug addiction in the United States is disproportionately concentrated among the unemployed and undereducated. And certainly most liberals would endorse measures to improve their lot. This, however, takes us far beyond the realm of drug policy. To maintain that we must end poverty and discrimination in order to combat drug abuse seems a prescription for paralysis. The key is to find a strategy that is humane, affordable and sellable--to find a strategy, in short, that could actually work.
Certainly such a standard would seem to rule out the third main school of left/liberal drug reform--legalization. On the surface, drug legalization has undeniable appeal. If drugs were legalized, the vast criminal networks that distribute them, and that generate so much violence, would disappear. Prison space would be reserved for the truly dangerous, black motorists would no longer be stopped routinely on the New Jersey Turnpike, relations with countries like Mexico and Colombia would improve and Americans would no longer be hounded for the substances they decide to consume--a matter of personal choice.
Yet legalizing drugs would entail some serious risks, the most obvious being an increase in abuse. While legalizers tend to cite drug prohibition as the source of all evil when it comes to drugs, drugs themselves can cause extensive harm. Heroin, cocaine, crack and methamphetamine are highly toxic substances, and those addicted to them engage in all kinds of destructive behavior, from preying on family members to assaulting strangers to abusing children. In all, there are an estimated 4 million hard-core drug users in the United States. Though making up only 20 percent of all drug users nationwide (the rest being occasional users), this group accounts for two-thirds to three-quarters of all the drugs consumed here. They also account for most of the crime, medical emergencies and other harmful consequences associated with drugs. If drugs were legalized, the number of chronic users could well increase.
History is full of cautionary examples. In the early seventies, for instance, doctors routinely began prescribing Valium (a minor tranquilizer) for everyday cases of anxiety. As the number of prescriptions increased, so did the incidence of abuse; by the late seventies Valium was sending more people to hospital emergency rooms than any other drug, heroin and cocaine included. As physicians became aware of Valium's dangers, they began writing fewer prescriptions for it, and the number of emergency cases began dropping as well. Clearly, making drugs easier to get can increase the extent to which they are abused, and one can only imagine what would happen if such potent intoxicants as heroin and crack suddenly became available by prescription or were sold openly. Under the regimes favored by some libertarians and free-marketeers, legalized drugs would be sold commercially and marketed aggressively, with potentially disastrous results for addicts and kids.
From a political standpoint, the liabilities of legalization are no less obvious. According to opinion polls, most Americans strongly oppose legalizing drugs. While the unpopularity of an idea should not automatically disqualify it, legalization seems a long-term loser. Indeed, the fact that legalization has so often been presented as the sole alternative to the drug war has hindered the movement for reform.
By now, the risks of legalization have become so evident that even onetime supporters no longer advocate it. Instead, they have embraced a variant of legalization called harm reduction. Not always easy to define, harm reduction generally holds that the primary goal of drug policy should not be to eliminate drug use but rather to reduce the harm that drugs cause. Those who can be persuaded to stop using drugs should be; those who can't should be encouraged to use their drugs more safely. To that end, harm reductionists favor expanding the availability of methadone, setting up needle-exchange programs, opening safe-injection rooms for heroin users and establishing heroin-maintenance programs that provide addicts with a daily dose of the drug.
There is much to admire in harm reduction. Its encouragement of tolerance for drug addicts provides a welcome alternative to the narrow moralism of the drug war. At times, though, harm reductionists take tolerance too far. In their eagerness to condemn the drug war, they sometimes fail to acknowledge the damage that drug addiction itself can inflict. While rightly condemning the political hysteria surrounding "crack babies," for instance, harm reductionists tend to overlook the havoc crack has wrought on inner-city families. And, while commendably calling for more needle-exchange programs, they rarely acknowledge that syringes are often handed out indiscriminately at these exchanges, with little effort to intervene with addicts and get them to address their habits.
Nonetheless, harm reduction--by recognizing that chronic users are at the core of the nation's drug problem and that they constitute a public-health rather than law-enforcement problem--can help point the way toward a more rational drug policy. The key is to develop a policy that is as tough on drug abuse as it is on the drug war.
In formulating such a policy, a good starting point is a 1994 RAND study that sought to compare the effectiveness of four different types of drug control: source-control programs (attacking the drug trade abroad), interdiction (stopping drugs at the border), domestic law enforcement (arresting and imprisoning buyers and sellers) and drug treatment. How much additional money, RAND asked, would the government have to spend on each approach to reduce national cocaine consumption by 1 percent? RAND devised a model of the national cocaine market, then fed into it more than seventy variables, from seizure data to survey responses. The results were striking: Treatment was found to be seven times more cost-effective than law enforcement, ten times more effective than interdiction and twenty-three times more effective than attacking drugs at their source.
The RAND study has generated much debate in drug-research circles, but its general conclusion has been confirmed in study after study. Yes, relapse is common, but, as RAND found, treatment is so inexpensive that it more than pays for itself while an individual is actually in a program, in the form of reduced crime, medical costs and the like; all gains that occur after an individual leaves a program are a bonus. And it doesn't matter what form of treatment one considers: methadone maintenance, long-term residential, intensive outpatient and twelve-step programs all produce impressive outcomes (though some programs work better for certain addicts than for others).
To be effective, though, treatment must be available immediately. Telling addicts who want help to come back the next day or week is a sure way to lose them. Unfortunately, in most communities, help is rarely available immediately; long waiting lists are the rule. In New York State alone, it is estimated that every year 100,000 people who would take advantage of drug or alcohol treatment if it were available are unable to get into a program.
Such numbers reflect the government's spending priorities. Of the $18 billion Washington spends annually to fight drugs, fully two-thirds goes to reduce the supply of drugs and just one-third to reduce the demand. In all, less than 10 percent of federal funds go to treat the hard-core users, who constitute the real heart of the problem. Closing the nation's treatment gap should be a top priority for the government.
How can we make this happen? According to federal estimates, the government would have to spend about $3.4 billion a year on top of current treatment expenditures to make help available to all who want it; the states would have to spend roughly an equivalent amount. If the current 67/33 percent split in the federal drug budget between the supply and demand sides were equalized, this would free up close to the sum in question at the federal level. Actually, a strong case could be made for reversing these proportions and allocating two-thirds to the demand side, but a 50/50 split seems as much as can be hoped for in the current political climate.
Finding a more effective means of preventing drug use among young people is another urgent need. Today, prevention consists mainly of Just Say No messages broadcast on TV or preached in the classroom. Unfortunately, research shows that such messages by themselves do not work. To succeed, prevention, like treatment, needs to focus on those most at risk. The problem is not so much with kids who smoke an occasional joint but with those who regularly use drugs and/or alcohol. For youths living in poor neighborhoods, effective prevention would mean more recreational programs, after-school activities and summer job opportunities (a key plank of the root-causes school). For more privileged students, prevention might take the form of early-warning systems in which teachers, counselors and parents work together to intervene with youths who show signs of getting into trouble with drugs, legal or otherwise.
As for the nation's drug laws, the goal should not be abolishing them--keeping drugs illegal can help contain abuse--but making them more rational so that small-time offenders are not hit with excessive penalties. And, whenever possible, nonviolent addicts and sellers who are arrested should be offered treatment as an alternative to incarceration. More generally, arresting low-level offenders should be society's last, not first, line of defense.
A word on marijuana. At present, almost 700,000 people a year are arrested for the sale or possession of pot. This is madness. Marijuana is far less toxic than heroin, cocaine or even alcohol, and the idea of putting people in jail for possessing it seems absurd. At the same time, marijuana is not innocuous, especially for young people, and we do not want to do anything that would make it even more available than it is now. Legalizing marijuana would certainly risk that. A far more rational approach would be to decriminalize the drug; people caught using pot in public would be subject to a civil penalty punishable by a fine, much as a traffic violation is. The production, importation and sale of marijuana, however, would remain illegal (though not subject to the ridiculously harsh penalties now in place). Decriminalization offers a realistic middle ground between the excesses of our current approach and the potential perils of legalization.
In my recent book The Fix, I argue that a public-health approach to the drug problem can work based on the one time we actually tried it--during the Nixon Administration. Nixon, a staunch law-and-order advocate, is remembered for having launched the war on drugs, but, drawing on his pragmatic instincts, he in fact made treatment his main weapon in that war. Confronting a national heroin epidemic, the White House created a special action office headed by physicians and addiction specialists, who spent hundreds of millions of dollars to set up a national network of clinics that offered help to all those who wanted it. The result was a marked decline in heroin-related crime, overdose deaths and hospital emergency-room visits. The national heroin epidemic was thus stanched.
Unfortunately, that network largely disintegrated during the Reagan years, so that by the time crack struck, treatment clinics were completely overwhelmed. Today, our drug problem is far larger and more complex than it was under Nixon. But the research confirming treatment's effectiveness has grown, too, and in light of the ongoing failure of the drug war, a public-health approach stressing treatment over prosecution, counseling over incarceration, would seem to offer our most humane, practical and politically viable alternative.